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NAT Success: Shining a light on drug related deaths

NAT Success: Shining a light on drug related deaths

19/05/2016

In 2014 3,346 people across England and Wales died because they had a drug overdose. This is the highest number since records began and in England this represents a 17% rise from the previous year, a dramatic deterioration of the situation for people who use drugs in this country.

The data found that 67% of deaths involved illegal drugs (those involving Heroin and Cocaine both rose), men were 2.5 times more likely to die than women, and those aged 40-49 had the highest death rate. As 2% of all people who have HIV in the UK acquired it through injecting drug use NAT works to ensure that drug-related policy is designed to reduce harm and HIV risk.

In response to this data, we wanted to see a change in the way we as a society measure the success of treatment for people with problematic drug use. Currently this is done through the Public Health Outcomes Framework (PHOF), which sets out expectations of what the public health system as a whole should be achieving with measurable indicators. By measuring how each local authority is doing against these indicators we can see which areas of the country are doing well and which areas are failing problematic drug users and their communities – and of course see where improvements can be made.

Up until now, the sole indicator specifically relating to drug use was the number of people who had successfully finished all drug treatment, including coming completely off Opioid Substitution Therapy, usually methadone. This prioritised an abstinence-based approach rather than a harm-reduction one that looked at the effect drugs were having in a person’s life. This single indicator was seriously inadequate by not going far enough to address the health harms associated with injecting drug use – the most extreme being death.

For instance, it took no account of the importance of deaths, deaths of those who haven’t accessed treatment in the first place, or those who die during treatment or soon afterwards.

In October last year when the Department of Health wanted to get views on the current set of indicators, NAT took the lead in arguing strongly that drug related deaths must be included as a new sub-indicator. We made the case that it would enhance our understanding of the successful completion of drug treatment as it will show whether we are succeeding in supporting those affected into treatment in the first place, and whether its completion is successfully managed to avoid overdose and relapse.

Last week we discovered that Public Health England took on our recommendations and changed the measure for drug use to include an indicator on drug-related deaths. From now on drug-related deaths will be an essential marker and driver locally of high quality and effective drugs services by ensuring local authorities are judged by how many of their residents die on their watch.

The importance of this change cannot be overstated. As with sexual and reproductive health services, drugs and alcohol services are the only elements of local authorities’ public health responsibilities which involves the direct medical care of those with serious ill-health. So making sure the right checks and balances are in place is vital. More importantly, unlike sexual and reproductive health services, there is no legal requirement for local authorities to provide any drugs and alcohol services at all.

By analysing how many people are dying of drug overdoses in their areas local authorities failing to offer any drugs and alcohol services will have to explain why.